Pulmonary complications after laparoscopic liver resection

Surg Endosc. 2021 Apr;35(4):1659-1666. doi: 10.1007/s00464-020-07549-w. Epub 2020 Apr 13.


Background: Although postoperative pulmonary complications (PPCs) are one of the common complications after liver surgery and might be avoided with the use of a laparoscopic approach, few reports have focused on the comparison of PPCs between laparoscopic liver resection (LLR) and open liver resection (OLR). The aim of this study was to clarify the effect of LLR on PPCs.

Methods: The study included 307 patients who underwent liver resection, excluding biliary reconstruction, at our institution between 2014 and 2018. Patients were divided into the OLR and LLR groups. The perioperative outcomes and PPCs were compared between the two groups using propensity score matching. On day 3 after liver surgery, all patients had chest radiography to confirm the presence of pleural effusion, including cases that required thoracentesis, and pneumonia.

Results: Of the 307 patients, 172 and 135 patients were included in OLR and LLR groups, respectively. After propensity score matching, 65 patients were included in each group. Compared with the matched OLR group, the matched LLR group had significantly lower intraoperative blood loss (P < 0.001); rate of intraoperative blood transfusion (P = 0.011); overall PPCs (P = 0.032); and number of cases with chest radiography-confirmed pleural effusion (P = 0.048), pleural effusion requiring thoracentesis (P = 0.029), and pneumonia (P = 0.012). Moreover, postoperative hospital stay was significantly shorter in the matched LLR group than in the matched OLR group.

Conclusions: Compared with OLR, LLR might be a better surgical approach to avoid PPCs.

Keywords: Laparoscopic liver resection; Open liver resection; Pleural effusion; Pneumonia; Propensity score matching; Pulmonary complications.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Hepatectomy
  • Humans
  • Laparoscopy / adverse effects*
  • Liver / surgery*
  • Lung Diseases / etiology*
  • Male
  • Middle Aged
  • Postoperative Complications / etiology*
  • Postoperative Complications / surgery
  • Propensity Score
  • Retrospective Studies
  • Treatment Outcome